The association between hospital high-volume anesthesiology care and patient outcomes for complex gastrointestinal cancer surgery: a population-based study

Objective — To examine the association of between hospital rates of high-volume anesthesiology care and of postoperative major morbidity.

Summary Background Data — Individual anesthesiology volume has been associated with individual patient outcomes for complex gastrointestinal cancer surgery. However, whether hospital-level anesthesiology care, where changes can be made, influences the outcomes of patients cared at this hospital is unknown.

Methods — We conducted a population-based retrospective cohort study of adults undergoing esophagectomy, pancreatectomy, or hepatectomy for cancer from 2007 to 2018. The exposure was hospital-level adjusted rate of high-volume anesthesiology care. The outcome was hospital-level adjusted rate of 90-day major morbidity (Clavien-Dindo grade 3-5). Scatter plots visualized the relationship between each hospital’s adjusted rates of high-volume anesthesiology and major morbidity. Analyses at the hospital-year level examined the association with multivariable Poisson regression.

Results — For 7,893 patients at 17 hospitals, the rates of high-volume anesthesiology varied from 0 to 87.6%, and of major morbidity from 38.2 to 45.4%. The scatter plot revealed a weak inverse relationship between hospital rates of high-volume anesthesiology and of major morbidity (Pearson −0.23). The adjusted hospital rate of high-volume anesthesiology was independently associated with the adjusted hospital rate of major morbidity (rate ratio 0.96; 95% confidence interval 0.95-0.98; P-value<0.001 for each 10% increase in the high-volume rate).

Conclusions — Hospitals that provided high-volume anesthesiology care to a higher proportion of patients were associated with lower rates of 90-day major morbidity. For each additional 10% patients receiving care by a high-volume anesthesiologist at a given hospital, there was an associated reduction of 4% in that hospital’s rate of major morbidity.